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Trauma in infants less than three months of age
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this type of injury, then RI-I should be fairly common in children with moderate to severe head injury. Children with suspected abuse or penetrating injuries were excluded. None of the 70 children with history of a fall were found to have RH, and only 2 children involved in lateral impact automobile accidents with severe head injuries were found to have RI-I. The authors conclude that RI-I is rare in association with accidental trauma, and the forces required to produce SBS are extraordinary and not attributable to ca[John E. Long, MD] sual shaking. Editor’s Comment: While the age range of these patients is well outside that seen for SBS, RI-I remains an extremely unusual finding outside of the setting of non-accidental trauma.
0 TRAUMA IN INFANTS LESS THAN THREE MONTHS OF AGE. Stewart G, Meet? K, Rosenberg N. Pediatric Emergency Care. 1993;9:199-201. This study attempts to describe the characteristics of traumatic injury in infants less than 3 months of age and to determine whether non-accidentally-injured infants are at increased risk for subsequent trauma. Registration logbooks from the Children’s Hospital of Michigan Emergency Department (ED) were used to identify infants less than 3 months of age presenting with traumatic injury between June 1, 1990, and May 30, 1991. Infants with birth trauma were excluded. Data were collected for age, sex, birth weight, encounter date, number of previous ED visits, mechanism and type of injury, suspected abuse/neglect, radiographic studies, social or protective service involvement, and disposition. Medical records were reviewed 1 year after presentation to determine the subsequent number of ED visits, hospitalizations, and traumatic injuries. Twenty-eight percent (31/l 11) of traumatized infants in this study were injured under abusive or neglectful circumstances. Non-accidental trauma appears to have a peak occurrence from July to September. Falls accounted for the majority of accidental trauma, which is the leading cause of non-fatal injury in children nationwide. Motor vehicle accidents accounted for 8 of 111 injuries; of these, 5 infants were unrestrained and were considered to be nonaccidental trauma. Fifty-five percent of infants with fracture were abused or neglected. More specifically, there were more skull fractures and more metaphysealepiphyseal fractures in the non-accidental group. Injury suffered by the non-accidental group was more severe than in the accidental group. The majority of non-accidentallyinjured infants had social/protective services intervention and a subsequent decline in use of the ED. The authors felt that this decline was due to caretakers feeling threatened by the intervention who sought care elsewhere. The authors conclude that non-accidentally-injured infants less than 3 months of age sustain more severe injury and are at increased risk for subsequent trauma. [Marc Abramow, MD]
The Journal of Emergency Medicine
0 HEAD INJURY AND FACIAL INJURY: Is THERE AN INCREASED RISK OF CERVICAL SPINE INJURY? Hills MW, Deane SA. Journal of Trauma. 1993; 34549-54. This prospective study reviewed 8245 blunt trauma victims treated at Westmead Hospital in New South Wales, Australia, to determine the risk of cervical spine injuries with concomitant head or facial injuries. Four and a half percent of the patients with significant head injuries were determined to have cervical spine injuries, and only 1.1% of the patients had cervical spine injuries without serious head injuries. This study also noted that 72.4% of the cervical spine injuries occurred in motor-vehicle-related accidents as opposed to only 31.6% occurring in the remainder of the blunt trauma patients. Of those patients with facial injuries, there was no significant increased risk for cervical spine injuries. This study re-emphasizes the importance of cervical spine protection in head trauma victims. [Bold R. Hood]
0 CAN PATIENTS WITH MINOR HEAD INJURIES BE SAFELY DISCHARGED HOME? Taheri PI, Karamanoukian H, Gibbons K, Waldman N, Doerr RI, Hoover EL. Arch Surg. 1993;128:289-92. Patients with temporary loss of consciousness and a normal mortal status often undergo CT to rule out occult closed-head injury. For a 1Zmonth period, all patients with a history of altered level of consciousness who presented to an adult Level 1 trauma center were admitted for observation and neurosurgical consultation. Patients with neurologic findings underwent CT; those without neurologic findings had skull roentgenography. Using the discharge coding, all patients whose diagnosis included a closed-head injury had their chart reviewed with medical and demographic data recorded. Four hundred seven patients suffered closed-head injury, with 71 classified as major head injury (requiring neurosurgical intervention or close observation) and 336 as minor head injury (not requiring neurosurgical intervention or close observation). Of 310 patients with a Glasgow Coma Score (GCS) of 15, 5 patients required medical or surgical intervention for increased intracranial pressure. All 5 of these patients had evidence of skull fracture by physical exam, by skull roentgenography, or by CT scan. Four of these 5 patients had focal neurologic findings, and 3 were intoxicated. As no closed-head injuries were missed in those patients with GCS of 15 without CT, the authors conclude that a patient with no focal neurologic deficits, no evidence of basilar skull fracture by exam, no evidence of intoxication, no other injury that requires admission, and a reliable observer may be safely discharged from the emergency department without CT. [David A. Meurer, MD] Editor’s Comment: The use of retrospective discharge criteria and lack of follow-up after discharge means that injuries may have been missed. The use of skull radiographs is not recommended in this setting.
this type of injury, then RI-I should be fairly common in children with moderate to severe head injury. Children with suspected abuse or penetrating injuries were excluded. None of the 70 children with history of a fall were found to have RH, and only 2 children involved in lateral impact automobile accidents with severe head injuries were found to have RI-I. The authors conclude that RI-I is rare in association with accidental trauma, and the forces required to produce SBS are extraordinary and not attributable to ca[John E. Long, MD] sual shaking. Editor’s Comment: While the age range of these patients is well outside that seen for SBS, RI-I remains an extremely unusual finding outside of the setting of non-accidental trauma.
0 TRAUMA IN INFANTS LESS THAN THREE MONTHS OF AGE. Stewart G, Meet? K, Rosenberg N. Pediatric Emergency Care. 1993;9:199-201. This study attempts to describe the characteristics of traumatic injury in infants less than 3 months of age and to determine whether non-accidentally-injured infants are at increased risk for subsequent trauma. Registration logbooks from the Children’s Hospital of Michigan Emergency Department (ED) were used to identify infants less than 3 months of age presenting with traumatic injury between June 1, 1990, and May 30, 1991. Infants with birth trauma were excluded. Data were collected for age, sex, birth weight, encounter date, number of previous ED visits, mechanism and type of injury, suspected abuse/neglect, radiographic studies, social or protective service involvement, and disposition. Medical records were reviewed 1 year after presentation to determine the subsequent number of ED visits, hospitalizations, and traumatic injuries. Twenty-eight percent (31/l 11) of traumatized infants in this study were injured under abusive or neglectful circumstances. Non-accidental trauma appears to have a peak occurrence from July to September. Falls accounted for the majority of accidental trauma, which is the leading cause of non-fatal injury in children nationwide. Motor vehicle accidents accounted for 8 of 111 injuries; of these, 5 infants were unrestrained and were considered to be nonaccidental trauma. Fifty-five percent of infants with fracture were abused or neglected. More specifically, there were more skull fractures and more metaphysealepiphyseal fractures in the non-accidental group. Injury suffered by the non-accidental group was more severe than in the accidental group. The majority of non-accidentallyinjured infants had social/protective services intervention and a subsequent decline in use of the ED. The authors felt that this decline was due to caretakers feeling threatened by the intervention who sought care elsewhere. The authors conclude that non-accidentally-injured infants less than 3 months of age sustain more severe injury and are at increased risk for subsequent trauma. [Marc Abramow, MD]
The Journal of Emergency Medicine
0 HEAD INJURY AND FACIAL INJURY: Is THERE AN INCREASED RISK OF CERVICAL SPINE INJURY? Hills MW, Deane SA. Journal of Trauma. 1993; 34549-54. This prospective study reviewed 8245 blunt trauma victims treated at Westmead Hospital in New South Wales, Australia, to determine the risk of cervical spine injuries with concomitant head or facial injuries. Four and a half percent of the patients with significant head injuries were determined to have cervical spine injuries, and only 1.1% of the patients had cervical spine injuries without serious head injuries. This study also noted that 72.4% of the cervical spine injuries occurred in motor-vehicle-related accidents as opposed to only 31.6% occurring in the remainder of the blunt trauma patients. Of those patients with facial injuries, there was no significant increased risk for cervical spine injuries. This study re-emphasizes the importance of cervical spine protection in head trauma victims. [Bold R. Hood]
0 CAN PATIENTS WITH MINOR HEAD INJURIES BE SAFELY DISCHARGED HOME? Taheri PI, Karamanoukian H, Gibbons K, Waldman N, Doerr RI, Hoover EL. Arch Surg. 1993;128:289-92. Patients with temporary loss of consciousness and a normal mortal status often undergo CT to rule out occult closed-head injury. For a 1Zmonth period, all patients with a history of altered level of consciousness who presented to an adult Level 1 trauma center were admitted for observation and neurosurgical consultation. Patients with neurologic findings underwent CT; those without neurologic findings had skull roentgenography. Using the discharge coding, all patients whose diagnosis included a closed-head injury had their chart reviewed with medical and demographic data recorded. Four hundred seven patients suffered closed-head injury, with 71 classified as major head injury (requiring neurosurgical intervention or close observation) and 336 as minor head injury (not requiring neurosurgical intervention or close observation). Of 310 patients with a Glasgow Coma Score (GCS) of 15, 5 patients required medical or surgical intervention for increased intracranial pressure. All 5 of these patients had evidence of skull fracture by physical exam, by skull roentgenography, or by CT scan. Four of these 5 patients had focal neurologic findings, and 3 were intoxicated. As no closed-head injuries were missed in those patients with GCS of 15 without CT, the authors conclude that a patient with no focal neurologic deficits, no evidence of basilar skull fracture by exam, no evidence of intoxication, no other injury that requires admission, and a reliable observer may be safely discharged from the emergency department without CT. [David A. Meurer, MD] Editor’s Comment: The use of retrospective discharge criteria and lack of follow-up after discharge means that injuries may have been missed. The use of skull radiographs is not recommended in this setting.